“Dr. Aggarwal, should we divert the plane towards Salt Lake City? Dr. AGGARWAL, Dr. Aggarwal, do you want to land in Salt Lake City?”
Until this point, it was always “Manik,” and it was a basic question. If I was right, my intern or resident would be enthused with my knowledge; if I was wrong, they would teach and likely talk me up to regain my confidence. Well, that was last month.
This month, it’s no longer Manik Aggarwal, MS4, and it’s certainly no longer enthusiasm versus an opportunity for didactics. Now, it’s Dr. Manik Aggarwal, MD, with a critical question to be answered urgently and an acutely sick patient at the bedside (err, in the airplane aisle).
As I left Portland that morning to get back home to Dallas, my best friend and I chatted all weekend about starting residency in the coming weeks. I did not realize that my first true test was moments away.
As I sat in the window seat of the exit row, I saw her stand up, grab her belly, and begin grimacing in an “impending doom” kind of way. She took a few steps in the aisle and collapsed. She literally crumbled to her knees. Without much thought or rationale at the time, I jumped over to help her. She was mostly non-responsive and had a very weak radial pulse, with a mild carotid pulse. She was mumbling her words and having a hard time staying alert. Then, those daunted and gut-wrenching words were spoken over the PA system: “We have a medical emergency. Are there are physicians on board?” Although I rejoiced in this call to my fellow colleagues, apparently none of them were on the plane to join me. With the help of outstanding crew members, I was able to sit the passenger-turned-patient upright.
As she began to mumble her words with slightly more clarity, she was able to deny chest pain and shortness of breath, but specifically said, “My belly started hurting just now and it’s going up to my chest, and I vomited and have had diarrhea for three days now.” This was followed by her then going pulseless and falling limp in seat 21F. Just like I learned in the House of God the prior week, before going into a code, check your own pulse. Thankfully mine was still ticking and we quickly went to work.
This was the moment that those words will forever be with me: “Dr. Aggarwal, do you want to divert to Salt Lake City?”
We attached an AED with fear she may be having an MI or another acute cardiac event that could lead to a potentially fatal arrhythmia. Much to our relief, she was sinus with a fluctuating but present pulse. With her benign past medical history and current history with signs and symptoms of dehydration, I administered water orally. Unfortunately, she vomited out the water and began fluctuating in consciousness again. At this point, I requested an IV kit with the basic assumption that if successful, she would perk right up, but if unsuccessful, we would be descending into Salt Lake City. Much to our excitement and relief, the IV was started successfully and normal saline flowed rapidly.
As expected with hypovolemia secondary to dehydration, she responded appropriately to the IV fluids and quickly began to perk up. There was no Salt Lake City, but there was a very anxious Dr. Aggarwal sitting in 21E the remainder of the flight.
As we began to descend into Dallas, the patient was chatting like normal and she politely asked out partial fear: “So you look awfully young … when did you finish your medical training?” Squeamishly, I suggested she wait for my answer until we land on ground before possibly sending her into shock again! With encouragement from her, I gulped and told her, “I walked across the stage during medical school graduation ten days ago … you are my first patient.”
Sharing this story with levity is fun and easy because we are all thankful that she did well. As a message to my medical students reading this: keep in mind that you’re learning pathophysiology to take care of a sick human being. Will better grades or board scores will be byproduct? Yes. Will getting into the residency of your choice serve as the ultimate sign of success? Yes. But, before you know it, it may be your ultimate decision to make. So, Future Doctor, are we diverting to Salt Lake City?